Netherlands National Drug Monitor - Research and Documentation ...

- In the early 1990’s about one million needles were exchanged annually in
Amsterdam. By 2007 this had dropped to 171,200, although there was a slight
upturn to 184,000 in 2008 (GGD Amsterdam). In Rotterdam the number of syringes
exchanged between 2000 and 2007 more than halved from 422,000 to 168,900.
However, in 2008, the NX centres ordered almost 75,000 more syringes from the
GGD than in the previous year (GGD Rotterdam).
- The long-term decline in the number of needles exchanged may possibly be
explained by the following factors: a drop in the number of heroin users in general,
a decline in the influx of drug users (often injecting) from neighbouring countries, a
decline in the popularity of injecting drugs in connection with health problems, the
increase in crack cocaine use and the higher death rate among injecting drug users.
It is not clear how the spike in 2008 should be interpreted. Perhaps the existing
group of users injected more frequently, or needles and syringes were re-used less
often. An unexpected rise in the number of injectors cannot be ruled out. Another
possibility is that needle exchange staff ordered larger quantities of supplies.
• In a recent qualitative study on infectious diseases among heroin users, key informants
from the whole of the Netherlands reported that needles are currently only shared in
emergencies, but that other injecting materials are borrowed regularly. These include
tourniquets, spoons, swabs and filters (Hoogenboezem et al., 2008a).
• Apart from sharing injecting materials, high-risk techniques are often used, such as
injecting in the groin and neck or in veins; injecting substances that are not soluble,
such as methadone liquid, Ritalin, paracetamol, benzodiazepines; using alternatives
to sterile water such as rainwater or canal water; or injecting under highly unhygienic
circumstances.
• Interviews with key informants have revealed the emergence of a new group of
high-risk injectors. In recent years there has been an increase in the number of
young Eastern-European heroin users in the Netherlands. These are thought to inject
frequently and excessively (see also §4.3) (Hoogenboezem et al., 2008b).
High-risk sexual activity remains widespread.
• However, few recent (national) data are available. According to the most recent
measurements taken among injecting drug users in various cities, failure to use
condoms occurred most frequently among long-term partners (76-96%), followed by
casual partners (39-73%) and clients (13-50%) (Van de Laar & Op de Coul, 2004).
• The number of visits to the GGD health services by drug users who participated in the
Amsterdam Cohort Studies on HIV/AIDS, in which drug users indicated having had
unprotected sex, dropped from 52% in 1990 to 40% in 1996. In the period following
(from1996-2004), this percentage remained stable (Lindenburg et al., 2006).
• Research conducted on street prostitution in Amsterdam found that virtually all street
prostitutes use drugs; four-fifths have ever used heroin, and a quarter have ever
injected (Korf et al., 2005a). Half the respondents reported having engaged in unprotected
oral sex and a quarter had unprotected genital sex with clients. The researchers
noted that these figures are likely to be an underestimate of the true situation.
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